Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects

Rex, Douglas K.; Smith, John W.; Ulbright, Thomas M.; Lehman, Glen A.

doi:10.1016/0016-5085(92)91817-n

Cited by 102 publications

(49 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…54 Imperiale et al 19 found a significant association between hyperplastic distal polyps and APN. Our results, however, confirm those of other studies 18,32,[55][56][57][58][59] that show that hyperplastic polyps are not predictors of APN. Results differ when the predictive value of different characteristics of distal adenomas were studied in multivariate anal yses.…”

supporting

confidence: 91%

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Ibáñez

Muñoz-Navas

Duque

et al. 2004

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

BACKGROUNDFor colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODSPrimary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma ≥1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTSNeoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONSA strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.Reprint requests: Maite Betés Ibáñez, MD, PhD, Departamento de Digestivo, Clínica Universitaria de Navarra, 31080 Pamplona, Spain. INTRODUCTIONMost colorectal cancers (CRC) develop from adenomas, 1-3 which have a long, asymptomatic phase during which they are detectable and curable. Excision of colorectal adenomas reduces the incidence and the mortality of CRC. 2,4-11 Therefore, CRC fulfills the criteria for benefit from screening. 12 In 1996, the United States Preventive Services Task Force recommended screening of asymptomatic adults over 50 years of age with either flexible sigmoidoscopy (FS) or fecal occult blood tests (FOBT). 13 These recommendations now are endorsed by the American Cancer Society, 14 the World Health Organization, 15 and by virtually all medical and surgical professional societies concerned with digestive diseases. 16,17 A positive FS or FOBT result is an indication for colonoscopy. The continuing high mortality rates for patients with CRC, together with two large studies that demonstrate that FS fails to identify a substantial proportion of proximal lesions, 18,19 have led many specialists to regard reliance on FS or FOBT alone as screening tests would be as wrong as mammography o...

show abstract

supporting

confidence: 91%

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Ibáñez

Muñoz-Navas

Duque

et al. 2004

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

show abstract

“…This finding concurs with the conclusions and outcomes of other investigators who have also reported on this topic. [12][13][14][15][16][17] In addition, this analysis demonstrated that there is a significant increase in odds of having a proximal neoplasm found on a routine screening examination if one is a Caucasian man, is a man not taking aspirin or NSAIDs, is of advancing age, has a history of cancer other than CRC, or is a woman actively taking estrogen. With the exception of the latter two variables, these factors too have been documented by other researchers to be associated with neoplasms in the large intestine.…”

Section: Discussionmentioning

confidence: 99%

“…To date, 13 trials have been conducted on the proposed topic and target population. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Although the authors of seven [5][6][7][8][9][10][11] of these studies have concluded that distal HPs do predict the presence of SPNs and necessitate colonoscopy, the authors of the remaining six [12][13][14][15][16][17] have reported that no such increased risk exists, thus nullifying the need for colonoscopy. Moreover, beyond these visible discrepancies within the published literature, there are also tangible inconsistencies among the formal recommendations made for patients with distal HPs discovered by screening FS.…”

Section: Risk Of Proximal Colonic Neoplasms In Asymptomatic Adults Olmentioning

confidence: 99%

Risk of Proximal Colonic Neoplasms in Asymptomatic Adults Older Than 50 Years Found to Have Distal Hyperplastic Polyps on Routine Colorectal Cancer Screening

Collins¹

2010

TPJ

View full text Add to dashboard Cite

“…Similar investigations reported confl icting fi ndings (1,3,20,28) . However, most well-designed studies point out that hyperplastic polyps are not associated with an increased risk of neoplasia (6,36,41,46) . Most advanced lesions were found in the distal colon in our study.…”

Section: Discussionmentioning

confidence: 99%

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population

Binda

Pereira-Lima

Nunes

et al. 2007

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Background -Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. Aim -To study the correlation between distal and proximal colonic neoplasias in symptomatic patients 50 years or older and patients 40 to 49 years old who underwent colonoscopy at a gastrointestinal endoscopy unit in 1999 and 2000 with the purpose to evaluate its role in a symptomatic population. Methods -All colonoscopies performed in our Department in 1999-2000 were reviewed. The distal colon was defined as the colonic segment aboral to the splenic flexure. Advanced neoplasias were defined as adenomas larger than 10 millimeters and adenocarcinomas. Results -Of the 2,701 colonoscopies retrieved, 1,125 were enrolled in this study. Prevalence rates for adenoma, advanced adenoma and carcinoma were 28.9%, 4.6% and 4% in the group of 830 patients 50 years or older (mean age 65 years, 491 women). The finding of one small (<10 mm) adenoma in the distal bowel doubled the likelihood of finding a proximal neoplasia (OR = 2.12, 95% CI, 1.27-3.54), and multiple (OR = 3.99, 95% CI, 1.72-9.28) or advanced (OR = 3.73, 95% CI, 1.81-7.7) adenomas increased this risk even further. Of the patients without adenoma or carcinoma in the distal colon, 1.93% had proximal advanced neoplasia. In the group of 40 to 49-year-old patients (n = 395; mean age 44.8 years, 208 women) the prevalence of adenomas (14.9%), advanced adenomas (3.4%), and carcinomas (1.7%) was lower. Conclusions -The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older with an apparently normal distal colon has advanced proximal neoplasia. Sigmoidoscopy is not an adequate exam for symptomatic patients aged 50 years or older. HEADINGS -Colonoscopy. Sigmoidoscopy. Proctoscopy. Colonic polyps. Colorectal neoplasms. Adenoma.

show abstract

Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects

Cited by 102 publications

References 9 publications

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Risk of Proximal Colonic Neoplasms in Asymptomatic Adults Older Than 50 Years Found to Have Distal Hyperplastic Polyps on Routine Colorectal Cancer Screening

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population

Contact Info

Product

Resources

About